Random thoughts from a few cantankerous American physicians. All contributors are board certified. Various specialties are represented here. I do not know where this will lead but hope it will at least be an enjoyable read. All of the names mentioned in this blog are pseudonyms, the ages have been changed, and in half the cases the gender as well. All photographs are published with patient consent or are digitally altered to preserve anonymity. Trust us, we're doctors.

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Wednesday, August 06, 2008

Here is the bag 'o pills brought in by a very nice gal tonight. This gal gets her care at the VA. There are some fantastic docs at the VA. Since their system is high on procedure and protocols it is light on personal responsibility on the doctor side. It's not that the docs don't want the personal responsibility, it's that the system doesn't allow for it. Worse, patients often see different providers at every visit. In other words, it's a lot like getting your primary care at the ER, which is what lots of folks do today. Here is the result. Half of these expensive and dangerous medicines are duplicates. No doctor-patient relationship. This gal is very sick. She will be admitted but guess what, the VA is 'full'. We are admitting her here but we don't know jack shit about her history and the VA medical records department is closed for the night. This is what the government does with health care. Do you want this for you and your family? I think not.

41 comments:

This is a very common story and these things should never happen. The single payer system has its problems, but I have an HMO that is too expensive to use. My copays are too high. I can't afford medications, and I can't afford to see a doctor. It's crazy. I keep paying more each year for my policy and I keep getting less. I'll vote for anyone that comes up with a way of fixing the problem. There has to be a better way.

i believe i. my uncle suffered a stroke after visiting the va where they sent him home with a syringe of something to self-administer to lower his bp. we don't know what because it seems to take forever to get anyone to talk to us. before the stroke, he was told he'd have to wait 6 wks to be seen and he'd be better off going...to the ER. he's recovering but the va doesn't have room for him. seems they're full in AZ too. ain't it dandy?

that's quite a heap of meds... even as someone who is able to get decent health coverage, i've long thought that the whole system needs reworking. i just wrote a mini rant about it after reading an article about doctors setting up free clinics in appalachia to care for patients who have had to get full mouthfulls of teeth pulled, etc. due to a lack of sufficient coverage/funds of their own. i don't know much about it, but i've always sort of been interested in what doctors have to say about the whole thing... guess i'll keep checking up on your blog.

hi,this is not related to the VA post, but...well here goes. Injured in 1993, fell 26'. Landed on ass and hands trying to break fall. Most r wrist crushed, bi-lateral shoulder fuckall, fell forward then onto piece of steel-lost spleen yadada yadada. 6 years later, meckels(?)diverticulum and peritonitis, thought i had food poisoning OOps, 10 days out of surgery another intestinal block from adhesions from meckels surgery. I was always treated by my doctors in proportion to the respect i gave them. I knew the hours, the fuckall patients they had to deal with etcetera ectetera...and you know what. I'm okay. Cause for the most part docs are okay. Just like any other group of people there will no doubt be some genetic throwbacks...but...like most things, you can't always get what you want, but if try sometime, you just might find...that you will get good doc's...hats off. Dont quit.

I want some of the Percodan to take the pain away. I know for a fact there was Percodan in that pile. 911-at least they didn't bring you a handful of piles and say "here's what she takes at night", like I got time to go to the PDR or online.

Wow, what an injury list. If you were on an 1870's wagon train they would have left you for buzzard bait. Glad to hear you are doing OK, and you know what, we are just like everyone else. After 13 years of ED medicine, there are days for me when 26 feet wouldn't be high enough.

By the way, I loved that book Shrodingers Cat, The Kitten's i am still working on, much deeper, very enlightening. Maybe you should try "Ishmael" if not for a different view, at least a good philosophical laugh.

The VA has been underfunded by the same people who have been working so hard to create new customers for them over the past 5 or so years. I don't understand docs' preference for being controlled by unregulated, profit-above-all-motivated, private-sector bureaucrats over a single-payer system.

Great blog. What say we reduce the size of govt. red tape and bureaucrats, decentralize, spend less money on corporate welfare for big pharma, and hand the power and money (in this case) back to the Doctors and the patients? http://www.ronpaullibrary.org/topic.php?id=22

omg i'm a speech pathologist who just quit acute care. not that i'm high on the totem pole, but the obvious lack of collaboration amongst professionals was appalling. intensivitists, hospitalists bickering between each other in the ICU, specialists not necessarily talking to one another. notes in chart but no one pulling it all together for the medically-complicated patients. everyone an island unto themselves. power struggles and egos. a couple of napolian complexes. one MD ordering a test and another getting pissed at the provider trying to do the test. healthcare sucks & you'd better know someone in it to assure you get good care if you're really sick. otherwise you can sit in the e.r. with obvious appendicitis symptoms & be sent home only to have your appendix explode. oh well, sucks to be that person. God bless you, doctors.

My husband returned from the military 14 years ago, and is working a government job because we can't live on just the retirement pay - and a huge part of that is that we need the additional health coverage the civilian job offers. The 'life-time medical care" promised us in 1978 has dissolved to what is now, in essence, only secondary insurance.

Congratulations - you guys made "Blogs of Note." I think that's awesome! This blog is an awesome site as well as a resource for the likes of a street medic like me. Please keep up the great posts.

As far as the bag o'meds goes: at the VA hospitals, unfortunately this happens all the time. It really blows, but how to fix it? And the bigger questions it whether or it's worth fixing or levelling it and starting over.

I don't know that anyone really knows the answer to those questions. And that really sucks.

I very rarely see a doctor these days. I believe that most of our illnesses can be prevented by meditation and nutrition. What we eat these days leaves a lot to be desired (to say the east)That's what i think.Esmeralda

Oh yeah, the wonderful VA that hasn't changed since its' mis-conception...It failed my father, brother, my husband, and myself. We cover WW2 through the Vietnam War. Not one of us received the care we needed, and had to seek outside help.Being an Army nurse did squat for me--it didn't matter how "much-in-the-face" I got (aka, I know about these things), it only po'd them and made things worse.Now we have another generation looking forward to the same thing...great, just great. Some things never change.

You know, sadly enough, that big ol' bag of medicine is common in the private sector as well- not just the VA. Actually I'm a little surprised because I heard (as of yesterday, as a matter of fact) that patients have to go through a pharmacist and counseling before they could even go to the pharmacy to get their meds. If MTM (medication therapy management) is utilized as much as it should be, hopefully in the future, this won't be as much of a problem. Pharmacists can play an integral part in the management of patient care. We, as pharmacists, need to take the opportunity, but our patients and our prescribers need to be willing to work with us! :)

Mother Jones (first comment): Change jobs. It's called capitalism and there's a nursing shortage on. We don't need to adopt a socialist system because you're unwilling to change jobs into one that offers better insurance or you're unwilling to adjust other spending to accomodate your current insurance.

Some of us followed the link since this was one of the "blogs of note". As far as what to do it's important for people to push in the opposite direction from regulation and standardization and centralization both on the government side and with corporate consolidation. The two together are like Laurel and Hardy. Bad things happen when they start to work together. As far as real solutions I would highly encourage people to follow the above link to the Ron Paul library and some of his specifics. On a lighter note here's a video on my blog from the movie "Brazil". In the vid. "Harry Tuttle" (Played by DeNiro) has become a common criminal because he goes around and fixes people's air conditioning without any paperwork.http://tectonicforces.blogspot.com/search?q=deniro

My Dad is retired USAF, he uses Tricare and only Tricare and that seems to cover his healthcare needs well. Granted he is in very good health and has never had any major pblm, but the co-pays for his meds and Dr visits are cheap.I know they were promised free healh care and end up having to pay a yearly premium, but compared to what I have to pay to a private insurance, it still is a good deal.

I still think America needs social health care. I'm not surprised by insurance companies not liking the idea. I am surprised by doctors not liking the idea.

Why don't you like it?

Mind, since I defected from the land of free-range, god-help-you-get-good-insurance medical care, to the land of a government-run HMO...I still prefer America's quality and quantity of care. I strongly dislike the INEQUALITY of America's care, though.

I do believe a country should take care of its people. We're it's greatest resource. Just makes good sense. They should do it extraordinarily well, though.

I think the best social health care would provide the quality and quantity and FREEDOM that the American system offers along with the socialistic aspects of the Canadian...EVERYONE gets the same care here. (Unless they're wealthy enough to fly south of the border and get *ahem* better/different/more available/already approved care.)

What do you think is the solution? Love to see a full series of posts on it! Love this blog!

i am not sure, after reading your post, why you like the idea so much. all socialized medicine will do, and all it has done in canada, is ration care. this is great if you are healthy, but if you are acutely ill then you are often screwed. you wait, often until you die, for your life saving surgery.

also, and this is more persuasive to me, please point me to one government program that does things better than it's private counterpart.

american medicine has already been crippled by emtala... the law which requires docs and hospitals to care for anyone who shows up regardless of their ability to pay, and now, outside large cities, the specialists are vanishing. it also doesn't matter under emtala if you are a wanted criminal or are in the country illegally... you get it for free.

the reasons for the flight of the specialists are more than just emtala, but, now that i think of it, please point to one socialist system that does anything other than spread misery and call it 'equality'.

to advocate for this system you need to believe that all folks will do what they should and maintain their health and not abuse the stuff they get for 'free'. it's not free, it raises taxes. and, as soon as socialized medicine is tried, the system crumbles, just like in the UK and canada.

folks do not realize that in canada, you can not get surgery for many conditions within months of your diagnosis. see prior post entitled 'blame canada'.

the canadian system right now is helped by the availability of a trip south of the border for all manner of specialty care and procedures for htose willing to pay for it. the canadian government hates this. if america wants this i'm telling you right now what will happen.

doctors will turn into bankers. we will work a schedule and turn off our phones at night. on a personal level this is fine for me, but not so good for the patient.

if you believe, on any level, that hard work and personal responsibility should have its rewards, then you cannot be for socialized anything. it is a system that aims at mediocrity and quickly acheives it. everyone is equally miserable and that is called 'fair'.

prior to emtala access to health care for the poor was much better than it is now and emtala is socialized medicine paid for by skyrocketing insurance premiums and cuts in doctors and nurses salaries. we are quitting in droves. i and my friend who posts as 'schrodinger's cat' are quitting emergency medicine mid career and it is almost ALL because of the never ending parade of ER abusers who know that they can get what they want for free.

now, because of the flight of specialists to the protection of huge medical facilities, there is no longer a urologist, pediatric surgeon, or neurosurgeon in our large town. they left because they got sick of providing care for free to the least deserving. the care they gave, under force of law, killed their personal lives as well as their bank accounts. and guess what, they aren't easily replaced.

we have been trying for years to get a neurosurgeon here to no avail. no one will come because they will never sleep and we don't have the nursing staff to run a neurosurg OR or a neuro ICU.

why don't we have it? because the ER in every town and city in america takes in 70% non payors and we have to see a huge amount of patients to break even.

same for docs in private practice... these docs have to see over forty patients a day to break even. this was not the case before emtala (again, socialized medicine by another name) and people chose to have personal physicians.

when emtala came down folks figured out that they could dump their private insurance and 'just go to the ER'.

of the 70% non payors we see, almost all have cars and cell phones and tatoos and smoke. they are making choices based on the fact that they don't have to budget for medical care.

how, in the name of all that is holy, is extending this to all going to do anything other than crush the best medical system in the world? why would anyone go into medicine in this system?

it is true that for geriatric patients that we spend a huge amount of money prolonging what, to me, seems like agony, but i do not believe that rationing care is anything other than evil, especially when the choice to ration said care is made by some ethereal government bureacracy.

the system that works the best, in every case, is to put the experts in charge of what they are experts at. doctors and patients and families can make decisions to ration care or forego life prolonging interventions, but it cannot be the government.

the huge bureacracy that has evolved just to deal with the impact of the unfunded mandate called emtala prevents delivery of affordable and excellent care. the very ones emtala was designed to protect are now the least likely to get care because the doctors that would give the care are not there.

here's my solution. make a visit to the ER more expensive than a visit to a primary physician. make an ambulance ride more expensive than a cab ride. when patients are treated under emtala and do not pay even a portion of their bill then give them community service. our crisis will vanish overnight.

my point is that there is nothing wrong with our current system that a small dose of personal responsibility can't fix.

right now people who work, pay taxes, and have medical insurance are paying for those that don't. it's called stealing and it's not any different because it's 'legal'.

you don't have to understand anything i'm saying except this... socialism is thievery, and, in socialism or communism, the producers ramp down their production because being productive ceases to be worth it.

if it's going to be done do it this way... have government sponsored insurance, hell, make it 'free' if you want by taxing EVERYONE (the 'poor' have to pay something... even $5 a month), but leave folks the option to supplement this bare bones coverage with private insurance in order to get the best, most timely care. many states have tried their own version of the canadian system and all have failed. 'tenncare' in tennessee is a good example of this. ten years and it's dead for all intents and purposes.

if you choose to 'go naked' then you will still get care, but it would be like the canadian system where you get in line. if you don't want to wait in line, then pay extra for the privilege.

this would be hugely better than the current system where the folks that 'go naked' get the same care as those that pay for insurance, only they don't pay a dime for it.

I am a patient at the local VA clinic in Grand Rapids, Mi, and I feel the care I get is top notch. I see the same doc every time. I have blood work done prior to each visit and he has all of the info on the computer when I sit down with him. He really cares about my diabetes, the pains my body has and my other complaints. I get my eyes examined once a year, get a prescription for new eyeglasses and once even got glasses for free. I have no service connected disability and am not poor. Not rich, but not poor. I have no medical insurance. The VA is a Godsend as far as I am concerned. Is this a form of "socialized" medicine? I imagine so. So, in my case, it shows that it can work if it is run by people who care. Our people at the VA in Grand Rapids care. When I thought I was having a heart attack, they sent me in for full tests, MRI-etc. No heart attack that year. The next year I did have a heart attack, three stents. 99% blockage in three arteries. 75% in the fourth. I had insurance at the time and was treated at the best hospital in the area, the Fred and Lena Meijer Heart Center. Would the VA have done as well? I don't know. I can only hope so, since I am now without insurance. Oh, by the way, a few years ago I almost cut my finger off. I went to a local emergency room. They took care of it and the VA paid the emergency room bill. That is damn good. Thanks VA. I am proud to have served my country and I guess they are proud to serve me. God bless America. Mustang Mike

oh, i love your soap box. i am working in a job well out of my area, well below my typical rate of pay (by about 50% in our 'non' recession) for the simple reason it has health insurance. the state i live in has this ill concieved idea of free care where basically grad students have figured out how to scam free expensive health care. i took out student loans. color me dumb but for me, free care was for the working poor who could pay based on ability to pay on a sliding fee: not grad students who wanted to opt out.

i'm tired of seeing friends take vacations to exotic destinations, buy the newest technology, etc and then plan on using the er system to cover medical needs and claim poverty. it is about personal choices - but it should come with consequences. if you choose not to have home owners insurance, the government doesn't back you and rebuild your house if it burns down. i like the community service idea.